Impact of small left ventricle on paroxysmal atrial fibrillation ablation

The China-AF registry study linked small left ventricles (LVD < 42 mm) to poor outcomes in atrial fibrillation (AF) patients. Whether paroxysmal AF (PAF) patients with smaller left ventricles with normal height and weight (LVD larger than 42 mm and less than the average LVD) benefit less than those with larger LVD from the AF radiofrequency catheter ablation (RFCA) procedure was concerned. The median LVD was 48 mm, and the AF patients were divided into a larger LVD group (LVD >48 mm) and a smaller LVD group (LVD <49 mm). Clinical follow-up was also investigated. The H2FPEF score is recognized as a convenient method for screening patients with heart failure with preserved ejection fraction (HFpEF), which further reduced the ventricular filling. A total of 133 AF PAF were enrolled. 56 patients were enrolled in the smaller LVD group. Among patients with H2FPEF scores >5, 11/22 patients with smaller LVs and 20/25 patients with larger LVs were free of AF (50% vs 80%, respectively; P = .037). Among patients with smaller LVs, 11/22 patients with H2FPEF scores >6 and 27/34 patients with H2FPEF scores <6 were free of AF (50% vs 79.4%, respectively; P = .039). Among the 35 patients with PFO, 19/35 had an LVD >48 mm, Compared with patients who did not have PFO, those with LVD >48 mm had a younger average age (61.6 ± 9.6 vs 65.5 ± 8.3 years, P = .019). The success rate of PAF RFCA was affected in AF patients with H2FPEF scores ≥ 6 points and a smaller left ventricle than in those with a larger left ventricle. When the LVD was >48 mm, AF patients with PFO were younger than patients without PFO.